1. Field of the Invention
The present invention pertains to surgical procedures conducted on bodily or anatomical tissue and, more particularly, to an apparatus and method for accomplishing various procedures during endoscopic and open surgery.
2. Discussion of the Related Art
Various steps are accomplished in both open surgery and endoscopic surgery. Generally the multiple steps require various operating instruments, or "end effectors". "Open surgery" refers to surgery wherein the surgeon gains access to the surgical site by a relatively large incision and "endoscopic surgery" refers to minimally invasive surgery wherein the surgeon gains access to the surgical site via one or more portals through which endoscopes are introduced to view the surgical site and through which instruments having end effectors, such as forceps, cutters, needle holders, cauterizers, clip applicators, and the like, are introduced to the surgical site.
The performance of an endoscopic procedure typically involves creation of one or more puncture sites through a wall of an anatomical cavity using a penetrating instrument including an obturator, such as a trocar, disposed within a portal sleeve. After the penetrating instrument has penetrated into the anatomical cavity, the obturator is withdrawn leaving the sleeve in place to form a portal in the cavity wall for the introduction of instruments such as endoscopes, scissors, forceps, needle holders and the like into the anatomical cavity.
The various end effectors at the distal end of the instrument are manipulated by the surgeon using controls disposed at the proximal end of the instrument. Of course, it is desirable to move the end effectors through various paths, depending on the step being performed. Traditionally, this was accomplished by moving the entire distal end of the endoscopic instrument. However, recently it has been proposed to provide a plurality of end effectors on a single endoscopic instrument to minimize the number of puncture sites and thus reduce the risk and healing time associated with endoscopic surgery. For example, copending U.S. application Ser. No. 08/758,648 filed Nov. 27, 1996, the disclosure of which is incorporated herein by reference discloses a device having two needle holders for suturing.
When a plurality of end effectors are incorporated into a single endoscopic device it is often desirable to move the end effectors individually with respect to one another without necessarily moving the entire distal end of the device. Also, it is often desirable to move the end effector through a predetermined path, such as an arc or the like, to manipulate tissue without repositioning the entire endoscopic device.
Of course, it is also generally desirable to minimize the size of each puncture site. Further, in order to permit operations on a wide range of tissue sizes, it is desirable to provide a wide range of relative movement between the end effectors. These objectives, minimal number/small size punctures and wide range of relative movement, are seemingly contradictory. Conventional devices have not achieved the above-noted objectives.
U.S. Pat. No. 5,582,617 discloses an endoscopic instrument having an end effector that can move from a position within the diameter of the barrel of the device to a position outside the diameter. However, this device must pivot about an axis that is transverse to the axis of the barrel and an axis that is coincident with the axis of the barrel and thus requires a complex movement and linkage to accomplish the disclosed functions. Accordingly, this device falls short of providing an end effector that can be utilized over a large working span for a wide range of applications.